Virus markers associated with vertical transmission of human T lymphotropic virus type 1 in Jamaica.

In a prospective study involving 150 mothers and their offspring in Jamaica, we examined maternal viral factors associated with the risk of transmission of human T lymphotropic virus type 1 (HTLV-1). Overall, the incidence of HTLV-1 infection among children was 8.3 occurrences per 1000 person-months. A higher maternal provirus level (odds ratio [OR], 1.9 per quartile) and a higher HTLV-1 antibody titer (OR, 2.2 per quartile) were independently associated with transmission to children, whereas the presence of anti-Tax antibody was not. Higher maternal antibody titers also were associated with older age at infection among children who were breast-fed for

Chemokine receptor gene polymorphisms and risk of human T lymphotropic virus type I infection in Jamaica.

Polymorphisms of some chemokine receptor genes and their ligands are associated with susceptibility and progression of human immunodeficiency virus infection. This study assessed whether these variants are also responsible for susceptibility to infection with human T lymphotropic virus (HTLV) type I. Frequencies of CCR5-Delta 32, CCR2-64I, and SDF-1-3'A genotype among 116 HTLV-I-positive and 126 HTLV-I-negative persons of African descent in Jamaica were 1.0%, 14.9%, and 5.4%, respectively. The association of HTLV-I infection with the most common variant, CCR2-64I, was examined in 532 subjects. Thirteen (5.4%) of 241 HTLV-I-negative subjects were homozygous for CCR2-64I, versus 3 (1.0%) of 291 HTLV-I-positive subjects (P=.005). Among HTLV-I carriers, provirus load and antibody titer were not significantly different in persons with CCR2-+/64I or CCR2-+/+. These findings suggest that CCR2-64I, or alleles in linkage disequilibrium with it, may affect the risk of HTLV-I infection in a recessive manner.

Comparison of HHV-6 antibody titers in West Africa and the Caribbean

Human herpesvirus-6 (HHV-6) infections seems to be ubiquitous early in life, but antibody responses vary by geographic area. We compared HHV-6 antibody titer in 123 West African and 122 Caribbean serum samples. A quantitative immunofluorescence assay (IFA) using antigens derived from an HSB-2 cell line was used to test for IgG HHV-6 (GS strain) antibodies. The prevalence of HHV-6 antibodies was high (98 percent) in both sites. African samples had a significantly higher geometric mean titer (GMT: 697) than did Caribbean samples (GMT: 99). There was no difference between males (GMT: 260) and females (GMT: 270) overall. Children up to and including 9 years old had significantly higher titers (GMT: 483) than did all others (GMT: 237), and female children tended to have higher titers than did male children. In both areas there was a trend towards highest titer at younger age, followed by a decrease in titer in the oldest age group. Environmental and host factors may explain these geographic differences in antibody responses between two groups of African origin. (AU)

Sibling adult T-cell leukemia/lymphoma and clustering of human T-Cell lymphotropic virus type I infection in a Jamaican family

BACKGROUND:- Human T-cell lymphotropic virus type I (HTLV-I) infection is endemic in Jamaica, with an estimated crude seroprevalence of 5percent. Adult T-cell lymphoma/Leukemia (ATL), a disease caused by HTLV-I, has an incidence of 1-2/100,000 in the Jamiacan population. Familial ATL has not previously been reported from Jamaica. METHODS:- Hospital records and histologic specimens of the two cases were reviewed. HTLV-I infection was confirmed by antibody testing and by polymerase chain reaction on paraffin-embedded tissue,where serum was unavailable. Family members identified by the patient's parents. After giving informed consent, family members were asked to complete an interviewer-administered questionnaire and to agree to phlebotomy. RESULTS:- ATL developed 10 years apart in two siblings from a Jamaican family at age 16 and 24 years. A study of 19 members of their extended family, including both parents, 2 grandparents, and 3 siblings, revealed an overall HTLV-I seroprevalence of 17 percent. This compared with 75 percent among parents and sibling living in the same household as the patients (AU)

Patterns of HTLV-1 infection among family members of patients with adult T-cell leukemia/lymphoma and HTLV-1 associated myelopathy/tropical spastic paraparesis - abstract

Human T-cell lymphotropic virus type 1 (HTLV-1) is strongly associated with both ATL and HAM/TSP. Only a small proportion of HTLV-1 infected individuals develop either of these diseases with lifelong risk estimates between 1 percent and 5 percent. ATL is believed to be related to early childhood infection via mother to child and HAM/TSP is thought to result from sexually or parenterally acquired infection in adulthood. Through the evaluation of HTLV-1 seroprevalence among family members of ATL and HAM/TSP patients we provide data that early life exposure is important for later development of ATL. Cases of ATV and HAM/TSP and their first degree relatives were enrolled in the study at the UWI, Jamaica, HTLV-1 seroprevalence rates were compared. We enrolled 25 ATL and 31 HAM/TSP families. All cases were HTLV-1 positive. Females accounted for 56 percent of ATL cases and 80 percent of HAM/TSP cases with mean ages of 43 and 49 respectively. The seroprevalence of HTLV-1 among mothers of ATL patients was 100 percent compared to 27 percent among mothers of HAM/TSP patients (p=0.0003). Among fathers of ATL subjects the seroprevalence was 80 percent vs 0 percent for HAM/TSP (p=0.05). The seroprevalence among all family members was 49 percent for ATL and 20 percent for HAM/TSP (p=0.0003). In contrast spouses ofHAM/TSP cases had a 86 percent seroprevalence compared to 57 percent among spouses of ATL cases. ATL and HAM/TSP evolve from distinct pathogenic pathways supported by differences in epidemiologic association. This premise is strongly supported by our observation that family members of ATL patients, particularly mothers have a significantly higher prevalence of HTLV-1 infection (AU)

Sibling ATL and familial clustering of HTLV-1 infection in a Jamaican family - abstract

Two siblings from a Jamaican family developed adult T-cell leukaemia/lymphoma (ATL) in 1979 and 1989 respectively. The latter was HTLV-1 seropositive. Our aims were, to study the seroprevalence of HTLV-1 in the household of the index cases and among relatives living in the same parish, to identify any relative with HTLV-1 associated diseases (ATL and HAM/TSP) and the presence of risk factors for acquiring HTLV-1 infection. Eighteen (18) family members including two parents, 2 grandmothers, 3 siblings, 7 uncles and 4 aunts of the index cases were studied. The medical records of the first sibling were reviewed. Both parents and 2 of the siblings' studies live in the same house as the index cases. Results of the enzyme-linked immunoabsorbent assay (ELISA) testing are shown on the pedigree. Four members of the index cases' household were antibody (Ab) positive, whereas no family member outside the household was Ab positive. The sero status of the first case of ATL is unknown as she died in 1979. HTLV-1 Ab positive and Ab negative subjects had a similar mean age 34 and 38 years respectively. Neither group reported sexual contact with prostitutes or male homosexual activity. Among 18 healthy family members, no significant lymphadenopathy or neurological abnormality was detected. The high rate of HTLV-1 seropositivity among the family in the affected household (3/4 - 75) and the family overall (3/18 = 17 per cent) of the index cases were significantly greater than the general population (5 per cent). These findings support the theory that transmission is likely to take place horizontally, by sexual contact (husband to wife) and vertically (mother to child). The persistent Ab seronegativity of the 12 year-old child in the affected household is noteworthy, and the presence of other markers of HTLV-1 infection is being investigated (AU)

A prospective study of transmission by transfusion of HTLV-I and risk factors associated with seroconversion

To evaluate the risk of transfusion-related transmisssion of HTLV-I in Jamaica, a prospective study was initiated, prior to availability of a licensed HTLV-I serological screening assay. This information would prove useful in formulating strategies for blood-donor screening. We followed 118 pre-transfusion HTLV-I-negative transfusion recipients at monthly intervals post-transfusion for 1 year. Laboratory and questionnaire data were obtained at each visit to evaluate the clinical and immunological status of recipients. Cumulative incidence of HTLV-I seroconversion was estimated and risk-factor data associated with seroconversion among 66 HTLV-I-exposed transfusion recipients were analyzed. Seroconversion occurred in 24/54 (44 percent) of recipients of HTLV-I-positive cellular blood components, 0/12 recipients of positive non-cellular donor units and 0/52 recipients of HTLV-I-negative donor units. Significant risk factors associated with recipient seroconversion were receipt of a seropositive cellular blood component stored for less than one week odds ratio (OR) = 6.34, 95 percent confidence interval (CI) = 1.83 to 21.92], male sex (OR = 4.79, 95 percent CI = 1.15 to 20.0) or use of immunosuppressive therapy at time of transfusion (OR = 12.20, 95 percent CI = 0.95 to 156). Risk of blood-borne infection per person per year in Jamaica was estimated to be 0.009 percent. Our results confirm that blood transfusion carries a significant risk of HTLV-I transmission and that screening of donor blood effectively prevents HTLV-I seroconversion. Recipients at greatest risk for seroconversion were those who required multiple transfusions or who were receiving immunosuppressive therapy at the time of transfusion. These patients should be given priority in receiving selectively screened blood components, if universal blood-donor screening for HTLV-I is not possible (AU)

Clinical outcome following transfusion acquired HTLV-1 infection in Jamaica - abstract

To evaluate the acute and long-term risk of adverse clinical outcomes following transfusion acquired HTLV-1 infection, a prospective cohort of recipients were followed-up after transfusion between 1987 and 1988. Pre-transfusion seronegative recipients of HTLV-1 positive blood components were retrospectively identified and subsequently enrolled in the Jamaica Transfusion Study. Recipients were followed at monthly intervals post-tranfusion for one year, then semi-annually. Laboratory questionnaire data and a brief physical examination were obtained at each visit to evaluate the clinical, haematological and immunological status of recipients. Further diagnostic evaluation by dermatology, neurology, haematology and rheumatology were performed when clinically indicated. Sixty-six (66) recipients received Western Blot and/or RIPA confirmed HTLV-1 positive blood components; 24/66 recipients of confirmed positive components sero-converted. Five subjects, 4 sero-converters (SC) and one non-seroconverter (NSC), developed skin rashes 18-39 months post-transfusion [odds ratio (OR) = 8.2, Fishers exact test p = 0.06. One SC developed cleaved atypical lymphocytes on peripheral blood smear 32 months post-transfusion (PT). One SC developed TSP 36 months PT. Two NSC with transient antibody to HTLV-1 PT developed rheumatoid factor negative polyarthritis 20 and 25 months PT. Recipients of HTLV-1 sero-positive blood components appear to be at risk for adverse clinical events. As has been previously reported, TSP can develop after a short incubation period following transfusion findings reinforce the potential public health benefit of HTLV-1 testing of donor blood. However, in countries where health resources are limited, the feasibility of such screening is limited by financial constraints (AU)

Perinatal transfusion transmission of HTLV-I: risk to mother and child - abstract

As part of a prospective study of transfusion-transmission of HTLV-I antibody (Ab) positive blood in the perinatal period. Pretransfusion seronegative recipients of HTLV-I-positive blood components were retrospectively identified and subsequently followed up monthly for six months and then semi-annually thereafter. At each visit, a questionnaire was administered, physical examination was done and blood was drawn to assess haematological and immunological status of recipients. Mothers who were transfused during pregnancy had their pregnancy outcome noted and where possible were followed up as mother/infant pairs. The outcome of subsequent pregnancies was noted. Thirty-nine subjects in our cohort of 66 were women and 21 of them were transfused during pregnancy or in the puerperium . Nineteen of these women received cellular HTLV-I Ab-positive blood products and two received acellular products. Nine of our 21 mothers who received HTLV-I-positive blood products seroconverted, yielding a seroconversion rate of 42 percent which is consistent with the overall cohort. Fourteen of the 21 pregnancies ended in viable children but two mother/infant pairs wre lost to follow-up. Of the 12 remaining mothers, 4 received transfusion antepartum (1 day to 15 weeks prior to delivery), while 8 were transfused either interpartum or up to three weeks post partum. All of the 12 mothers breastfed their babies for periods ranging from one week to four years (median duration of six months). Six of the 12 mothers were sreoconverters and 2 of the six children of these mothers have also seroconverted between one and two years following birth. This yields a mother/infant transmission rate of 33 percent which is more than the reported 20 percent rate in previous mother/infant studies. The difference, however, is not statistically significant. One seropositive child has developed Infective Dermatitis (ID), a recently described HTLV-I associated disorder. We conclude that, HTLV-1 transmission via blood transfusion to pregnant women poses a risk to mother and child. We propose that, where widespread screening for HTLV-antibodies is not feasible, screening of blood for transfusion in to pregnant mothers should be given priority as at least two individuals are at risk of infection and disease (AU)

Peripheral T-cell lymphomas in Jamaica an analysis of the relationship between morphology, clinical features and HTLV-I serostatus - abstract

We analysed the clinicopathologic features of 111 patients with T-cell lymphoma in Jamaica. The lymphomas were classified histologically according to the recommendations of Rappaport, the National Cancer Institute (NCI) Working Formulation and the Lymphoma Study Group in Japan. Phenotypice classification was based on the results of immunohistochemical studies utilising a panel of monclonal antibodies directed against T and B lymphocytes. Serum samples were screened for HTLV-I antibodies using the enzyme-linked immunosorbent assay and the results were confirmed by Western Blot. The presence of clinical features of Adult T-cell leukaemia/lymphoma (ATL) were assessed and compared between HTLV-I seropositive and HTLV-I seronegative groups. Seventy-three patients (65.8 percent) were HTLV-I seropositive and 38 were HTLV-I seronegative. Marked morphologic heterogeneity was noted within both groups. As expected, within the HTLV-I seropositive group many patients showed clinical features of ATL such as hypercalcaemia (37/73), leukaemia (29/73), bone marrow involvement (18/73), skin infiltration (28/73) and lytic bone lesions (4/73). Clinical features of ATL were also seen within the HTLV-I seronegative group. Fourteen patients (36.8 percent) showed two of the clinical features of ATL. Twelve (31.6 percent) showed one of the clinical features of ATL. It is possible that these patients may be HTLV-I seronegative and proviral DNA positive and should therefore be included in the ATL group. Further studies are necessary to confirm this. The remaining seronegative patients represent cases of T-cell lymphoma that are not associated with HTLV-I infection (AU)

Tropical spastic paraparesis ocurring in HLTV-1 associated infective dermatitis: report of two cases

An association between HTLV-1 infection and infective dermatitis(ID), a relapsing eczematous condition of Jamaican children, was reported in 1990. These patients are at a risk of developing other known HTLV-1 related diseases. We have observed the development of HTLV-1 associated myelopathy/tropical spastic paraparesis im two patients, ages 14 and 35 years, who were diagnosed with ID at ages 2 and 10 years, respectively. Infective dermatitis of children serves as an early marker of HTLV-1 infection and may predict later development of either the malignant outcome, adult T-cell leukaemia/lymphoma or the neurologic manifestation HAM/TSP among adult carriers of HTLV-1 infection(AU)

Viral specific humoral immune responses following transfusion-related transmission of human T cell lymphotropic virus type-I infection

The immunoglobulin (Ig) isotypes of antibodies to specific proteins of the human T cell lymphotropic virus type I (HTLV-I) were determined by Western blot analysis of serial specimens from six individuals who experienced HTLV-I seroconversion following blood transfusion; five remained asymptomatic carriers, while one developed HTLV-I associated myelopathy/tropical spastic paraparesis (HAM/TSP) 32 weeks posttransfusion. Analysis of Ig isotypes demonstrated that while IgM was the most frequent early response to gag (p19, p24) and env (r21e) proteins within the first 3 months following transfusion, IgG and IgA responses could also be detected within this period. HTLV-I-specific antibody responses plateaued in all Ig isotypes, including IgM, wtihin the next 4- to 6-months period following transfusion and pesisted through the entire study period (> 4 years). Comparison of antibody profiles in Ig isotypes and IgG1 and IgG3 subclass among asymptomatic carriers and one individual who developed HAM/TSP demonstrated no evidence of isotypic prominence or IgG subclass restriction in either group. These results indicate the appearance of HTLV-I-specific IgM that persists even after the primary infection and suggest that such responses does not appear to provide an early marker of seroconversion. Further, we found no evidence of isotypic prominence or restriction of the antibody response in recipients who remained asymptomatic compared to one who developed HAM/TS.(AU)

Cervical intraepithelial neoplasia is not associated with elevated serum neopterin levels

Neopterin, a marker of cellular immune activation, was elevated in patients who had cervical cancer in previous studies. To examine neopterin in the presence of precursors to cervical cancer (i.e. cervical intraepithelial) we measured serum levels in 185 colposcopy patients in Jamaica, a country with high cervical cancer incidence, and in 72 age-matched Jamaican women selected from a large population-based sample. We also measured serum levels of B-2 microglobulin, another commonly used marker of immune activation. Neopterin and B-2 microglobulin levels were not elevated in colposcopy patients; neither were they rel ted to severity of cervical neoplasia. In multivariable analysis, neither adjustments for detection of cervical human papillomavirus DNA by PCR nor detection of antibodies to human T-cell lymphotropic virus type 1 (a retrovirus endemic to Jamaica) altered our findings. The absence of serologically detectable increase in cellular immune activation linked to cervical intraepithelial neoplasmia does not involve susbtantial systemic immune activation. (AU)

Role of HTLV-I in development of non-Hodgkin lymphoma in Jamaica and Trinidad and Tobago. The HTLV lymphoma study group

Human T-cell lymphotropic virus type I (HTLV-I) has been implicated in the aetiology of adult T-cell leukaemia/lymphoma in Japan and elsewhere, particularly the Caribbean. We have carried out parallel case-control studies in Jamaica and in Trinidad and Tobago to quantify the role of HTLV-I in the development of non-Hodgkin lymphoma (NHL). 135 cases of NHL were enroled in Jamaica and 104 in Trinidad and Tobago. Controls were selected from patients treated in the same wards or clinics at the same time as the cases. Overall, patients with NHL were 10 times more likely than were controls to be seropositive for HTLV-I (Jamaica odds ratio 10.3 [95 percent CI 6.0-18.0], Trinidad and Tobago 14.4 [7.6-27.2]). In both countries the association between NHL and HTLV-I was greatest for T-cell lymphomas (18.3 [9.5-35.6] and 63.3 [25-267]). Among T-cell lymphomas especially, there was no significant difference between men and women in the association between NHL and HTLV-I, but there was a significant inverse relation between age and likelihood of HTLV-I seropositivity. B-cell lymphomas were predominant in the older age groups and were not associated with HTLV-I seropositivity. These findings are consistent with the hypothesis that early life exposure to HTLV-I is important for risk of subsequent ATL. Prevention of vertical transmission of HTLV-I could reduce by 70-80 percent cases of NHL in people under 60 years in this region (AU)

Tropical spastic paraparesis ocurring in HLTV-1 associated infective dermatitis: report of two cases

An association between HTLV-1 infection and infective dermatitis(ID), a relapsing eczematous condition of Jamaican children, was reported in 1990. These patients are at a risk of developing other known HTLV-1 related diseases. We have observed the development of HTLV-1 associated myelopathy/tropical spastic paraparesis im two patients, ages 14 and 35 years, who were diagnosed with ID at ages 2 and 10 years, respectively. Infective dermatitis of children serves as an early marker of HTLV-1 infection and may predict later development of either the malignant outcome, adult T-cell leukaemia/lymphoma or the neurologic manifestation HAM/TSP among adult carriers of HTLV-1 infection

Estimating the time of HTLV-I infection following mother-to-child transmission in a breast-feeding population in Jamaica

Mother-to-child transmission of human T-cell lymphotrophic virus type 1 (HTLV-I) is primarily due to prolonged breast-feeding (>6 months) in the post-natal period. Most infant infections are not identifiable until 12-18 months of age by available whole virus Western blot serologic tests because of their inability to distinguish passively transferred maternal antibody from infant antibody. We investigated two methods to assess more accurately the time of infant infection. In prospectively collected serial biospecimens, HTLV-I-specific immunoglobulin (Ig) isotypes of IgM and IgA were determined by Western blot and HTLV-I proviral DNA was detected by polymerase chain reaction (PCR). IgA and IgG reactivity was assessed in periodic serum samples from 16 HTLV-I-seropositive children while IgM reactivity was observed in 100 percent of children at 24 months of age and 73 percent of children at 6-12 months of age; however, this could represent maternal and not infant antibody. Both IgA and IgM reactivity were insensitive indicators of infection, with only 50 percent of children showing reactivity at 24 months of age. PCR testing was performed in biospecimens obtained from 11 of these children. An estimated median time of infection of 11.9 months was determined by PCR, which was similar to the median time to infection determined by whole virus Western blot (12.4 months; P=0.72). PCR Tests support a median time to infection that is similar to that estimated by whole virus Western blot. (AU)

Human T-cell lymphotropic virus type I and severe neoplasia of the cervix in Jamaica

Human T-cell lymphotropic virus type I (HTLV-I) was associated with carcinoma of the cervix in Japan in a recent study that compared hospital cases with healthy population-based controls. To test this relationship in women more alike for cervical neoplasia risk factors (including sexual behavior and human papilloma virus: HPV), we enrolled consecutive patients from a colposcopy clinic in Kingston, Jamaica (an HTLV-1 endemic area). Patients underwent Pap smear, calopscopy, biopsy and cervical swab for detection of HPV by polymerase chain reaction. Cases were defined as women with CIN-3 or invasive cancer (CIN-3/CA). Controls included all patients with either CIN-1 or koilocytotic atypia, atypical squamous cells of undetermined significane or benign cervical pathology (all but one had at least inflammatory changes). Patients with CIN-2 were excluded to minimize risk of case-control misclassification. Cases were much more likely to be HTLV-1 seropositive than controls. Although mean age differed significantly between cases (mean age = 39 years) and controls (mean age = 33 years), control for age did not explain the relation of CIN-3/CA with HTLV-1. Among HPV DNA positive subjects the age-adjusted association was not diminished but lost statistical significance. HTLV-1 seroprevalence may be independently associated with progression to severe neoplasia of the cervix (AU)

Effect of human T-lymphotropic virus type I infection on non-Hodgkin's lymphoma incidence

We previously reported from a case-control analysis that T-cell non-Hodgkin's lymphoma (NHL) was strongly associated with human T-lymphomphotropic virus type I (HTLV-I) infection in Jamaica and Trinidad and that the relative risk for HTLV-I infection was very high in younger patients. Purpose: the objective of this study was to estimate the age-specific incidence rates of NHL among HTLV-I-infected and HTLV-I-uninfected adults in Jamaica and Trinidad. Methods: Population rates of HTLV-I infection were calculated from available census reports and serosurvey data. Incidence rates for NHL were calculated from all incident cases in Jamaica during 1984-1987 (n = 135) and from all incident cases in Trinidad during 1986-1990 (n = 117). Using biopsy material, we determined whether the immunophenotype or the tumor cells was T cell, B cell, or other. NHL incidence rates were computed according to HTLV-I status, age, sex, and tumor phenotype for each country separately and for both countries combined by weighting to the relative population size of each country. Results: The age-standardized NHL incidence rate (mean ñ SE) in Jamaica was 1.9 ñ 0.2 per 100,000 person-years (PY). In Trinidad, the rate was 2.9 ñ 0.4 per 100,000 PY. Overall, the incidence of NHL increased with age and was higher in males than in females. In the HTLV-I-infected population, the incidence of NHL was inversely related to age, and age-specific rates were higher in males than in females. The NHL incidence in those estimated to have acquired HTLV-I infection in childhood, however, showed no sex difference, and one in 1300 such carriers (95 percent confidence interval: one in 1100 to one in 1600) per annum were estimated to be at such risk. For T-cell NHL, as proxy for adult T-cell lymphoma/leukemia, incidence was highest in those patients infected with HTLV-I early in life (perinatally or via breast milk), with high, sustained risk from early adulthood in both sexes. Conclusions: While overall NHL incidence rates reveal that HTLV-I endemicity does not impose an exaggerated lymphoma burden on these populations, the risk for lymphoma among carriers who acquire infection early in life is dramatic and is consistent with the hypothesis that virus exposure early in life is most important for lymphomagenesis. Implications: Studies of HTLV-I carriers known to be infected in childhood may provide insight into markers intermediate in the lymphomagnetic process. Strategies to disrupt early-life transmission of HTLV-I, notably mother-infant transmission, may be critical in reducing the burden of lymphoreticular disease in these populations (AU)

Clinical, pathologic, and immunologic features of human T-lymphotropic virus type I- associated infective dermatitis in children

Objectives: To define the clinical and laboratory features associated with infective dermatitis (ID) and confirm its association with human T-lymphotropic virus type 1 (HTLV-I). Design: A case series of patients with ID were compared with patients with atopic dermatitis (AD) which is an important disease in the differential diagnosis of ID. Setting: Patients were recruited from dermatology and pediatric clinics at the University Hospital of the West Indies and the Bustamante Children's Hospital, Kingston, Jamaica. Main Outcome Measures: Clinical and laboratory features of patients with AD were compared with those of patients with ID. Patients: Consecutive patients older than 1« years diagnosed as having ID (n=50) and AD (n=35) were enrolled based on clinical findings. Results: The mean age of patients with ID and AD were 6.9 and 7.8 years, respectively. Histologically, both disease were predominantly chronic dermatitis... Conclusion: Infective dermatitis is a distinct clinical entity associated with HTLV-I, which plays a role in the pathogenesis and immune perturbations observed.(AU)

Human leukocyte antigen class II alleles associated with human T cell lymphotropic virus type I infection and adult T-vell leukemia/lymphoma in a black population

BACKGROUND: Human T-cell lymphotropic virus type I (HTLV-I) is linked to adult T-cell luekemia/lymphoma (ATL) and HTLV-I associated myelopathy (HAM; also known as tropical spastic paraparesis [TSP]), a chronic neurodegenerative disorder. Worldwide, several million HTLV-I carriers are at risk for disease, with an estimated lifetime cumulative risk of 1 percent-5 percent. However, the determinants of disease progression are relatively unknown. We studied human leukocyte antigens (HLA class II) that have been implicated in the pathogenesis of HTLV-I related diseases. METHODS: We analyzed HLA class II alleles among asymptomatic HTLV-I carriers (n = 45), patients with ATL (n = 49) or HAM/TSP (n = 54), and HTLV-I seronegative control subjects (n = 51). All participants were of African descent and were enrolled in epidemiologic studies conducted at the University of the West Indies, Kingston, Jamaica. We used standard microlymphocytotoxicity assays for HLA antigen serotyping and polymerase chain reaction-based methods to examine HLA class II DRB1 and DQB1 alleles. RESULTS: Two antigens determined by serotyping DR15 and DQ1, occurred at significantly increased frequency among HTLV-I carriers compared with seronegative control subjects (42 percent versus 22 percent for DR15 [odds ratio [OR] = 2.7; 95 percent confidence interval [CI] - 1.0-7.2] and 78 percent versus 53 percent for DQ1 [OR = 3.1; 95 percent CI= 1.2-8.5]). Asymptomatic carriers were shown to have and HLA class II allele distribution similar to that of patients with ATL, and the frequencies of the alleles DRB1*1501, DRB1*1101, and DQB1*0602 were significantly increased among patients with ATL compared with patients with HAM/TSP. CONCLUSIONS: These data suggest that host genetic background is an important factor in determining weather HTLV-I carriers develop either ATL or HAM/TSP.(AU)